Healthcare Provider Details

I. General information

NPI: 1700310364
Provider Name (Legal Business Name): FAMILY RESIDENCES AND ESSENTIAL ENTERPRISES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 SWEET HOLLOW RD FAMILY RESIDENCES AND ESSENTIAL ENTERPRISES, INC.
OLD BETHPAGE NY
11804-1314
US

IV. Provider business mailing address

191 SWEET HOLLOW RD FAMILY RESIDENCES AND ESSENTIAL ENTERPRISES, INC.
OLD BETHPAGE NY
11804-1314
US

V. Phone/Fax

Practice location:
  • Phone: 516-870-1600
  • Fax: 516-870-1658
Mailing address:
  • Phone: 516-870-1600
  • Fax: 516-870-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. ROBERT S. BUDD
Title or Position: CEO
Credential:
Phone: 516-870-1600